Sunday, October 16, 2011

The Stillbirth Summit Introduces the New Pregnancy Buzz Phrase ~ EPV!!!

Bear with me ~ to write about all the researchers and their findings present at the Stillbirth Summit in one sitting would require lots of time and several glasses of wine!!! So, I have decided to introduce you to one researcher per blog and write about what I took away from their lectures in my notes. If you are confused by my interpretation ~ you can Google it, research it & digest it. Take it or leave it; pass it on or delete it. Just know, these men and women will change the face of stillbirth with their passion and fire. They will pull stillbirth from the shadows and place it brightly in the light of day. They will find answers for us; prevention is their intention.
The Stillbirth Summit opened the eyes of all who attended. Dr. Alexander Heazell, MBChB, PhD, MRCOG, Maternal & Fetal Health Research Centre, University of Manchester, UK, delivered the simple yet poignant statement during the first presentation of a colleague, “We understand stillbirth very badly.” There was no pretentiousness. There were no scholarly noses looking down at us. The cards were on the table for everyone to see. Over the next 3 days the researchers would share their passion, frustrations and greatly needed research with us all.

When you listen to Dr. Harvey Kliman, MD, PhD, Director of Reproductive and Placental Unit, Yale University School of Medicine, you come away with one word embedded deeply in your brain: PLACENTA!!! The man is amazing and quick to state, “It is the simple things, tissue etc. which ends up in the pathology lab to be looked at. The information in it tells us why this loss happened.” Kliman is emphatic ~ the placenta is the key to what’s going on in a “loss” investigation and the placenta "must go to pathology."

While all eyes are on the fetus, Kliman explains a small fetus means a small abnormal placenta and “Doctors should know about abnormal placentas. Not knowing anything about the placenta is like driving a car without any gas!!!”

The “small” placenta is one major placental issue. The small placenta does not happen “all of the sudden.” The normal ratio of the fetus to placenta is 6:1. Once it goes beyond 7:1 or 8:1 it crashes. The placentas falling in the 10th to 90th percentiles are optimal. It is the ones which are in the < 10% or > 90% which will pose the problem. The baby and placenta tend to grow at the same rate and ratio up to 36 weeks. But what happens when the placenta is small and cannot supply the growing fetus? Intrauterine Growth Restriction (IUGR) develops. This concern plays a large part in delivering small and low birth weight babies, decreasing amniotic fluid (the amniotic fluid index) within the uterus, and putting your baby at risk for intrauterine death ~ if not detected. The extremes of a lesser ratio or a greater ratio between the baby and placenta indicate the need for diligent monitoring, care and concern.

One sign of a small and insufficient placenta is the onset of decreased fetal movements:

Can your heath care provider know about this beforehand? Yes.

Can something be done about it? Yes.

This can be detected by using standard ultrasound equipment. The measurement is called Estimated Placental Volume (EPV). Or, now there is even an EPV app,, for your phone. According to Dr. Kliman, EPV should be incorporated in prenatal care and would take all of 15 seconds to do!!! The app costs a mere $29.99!!! So ~ why is Estimated Placental Volume not being calculated by every doctor, midwife and health care member who sees a pregnant woman for her OB appointment? The overriding reason for using this simple and inexpensive device can mean the difference between life and death for your baby. If a small placenta is detected, mom and baby will be monitored closely and a happy healthy outcome is easily achievable as baby can be delivered early if necessary.

According to Kliman, the placenta is part of the fetus and should be checked at a 10 week ultrasound. It should then be checked by ultrasound around 18 weeks. If the placenta is small at this time, there is nothing to do but keep an eye on it. When the placenta is small or large, the need  for closer monitoring is needed. 

Sounds to me ~ Estimated Placental Volume deserves to be the new pregnancy buzz phrase of 2012. If you are pregnant, why not ask to have your baby’s EPV checked the next time you visit your doctor, midwife or health care team? You may ask, “Why?” Quite simply, your baby’s life might just be depending on it…


  1. Ok... this further proves that doctors are not doing what they should be when we are examined.

    This is wonderful information... God help my OB when I find out I'm pregnant again!!! I'm going in armed with so much info that they won't be able to stand me. I wish I had known all of this in 2010.

  2. Nneka,
    You are exactly right. Let me quote Dr. Craig Rubens, MD PhD.Co-Founder & Executive Director GAPPS:

    "Why focus on the last 1/2% of pregnancy during Labor and Delivery to understand why women have adverse outcomes during pregnancy. We need to focus on and study more the 99.5% of pregnancy that's going on currently."

    I rest my case...